A Clinical Assessment and Management of a Patient

A CLINICAL ASSESSMENT AND MANAGEMENT OF A PATIENT WITH FACULTATIVE HYPEROPIA Prepared By: Santos, Clarence O. Abstract Ametropia is an anomaly of the refractive state of the eye in which, with relaxed accommodation, the image of objects at infinity is not formed on the retina. Thus vision may be blurred. The ametropias are: astigmatism, hyperopia (hypermetropia) and myopia. The absence of ametropia is called emmetropia. The word “ametropia” can be used interchangeably with “refractive error” or “image formation defects. Types of ametropia include myopia, hyperopia and astigmatism. They are frequently categorized as spherical errors and cylindrical errors. Those who possess mild amounts of refractive error may elect to leave the condition uncorrected, particularly if the patient is asymptomatic. For those who are symptomatic, glasses, contact lenses, refractive surgery, or a combination of the three are typically used. Keywords Hyperopia, Ametropia, Facultative Hyperopia Introduction
Hyperopia, also known as farsightedness, longsightedness or hypermetropia, is a defect of vision caused by an imperfection in the eye (often when the eyeball is too short or the lens cannot become round enough), causing difficulty focusing on near objects, and in extreme cases causing a sufferer to be unable to focus on objects at any distance. As an object moves toward the eye, the eye must increase its optical power to keep the image in focus on the retina. If the power of the cornea and lens is insufficient, as in hyperopia, the image will appear blurred.
The causes of hyperopia are typically genetic and involve an eye that is too short or a cornea that is too flat, so that images focus at a point behind the retina. In severe cases of hyperopia from birth, the brain has difficulty merging the images that each individual eye sees. This is because the images the brain receives from each eye are always blurred. A child with severe hyperopia has never seen objects in detail and might present with amblyopia or strabismus. If the brain never learns to see objects in detail, then there is a high chance that one eye will become dominant.

The result is that the brain will block the impulses of the nondominant eye with resulting amblyopia or strabismus. Case Report Michelle Tizon, a 19 year old female had a routine eye checkup last July 23, 2012. She does not wear any corrective lenses. The patient does not report any symptoms of visual deficiencies and declares that she has clear vision at any distance. The patient claims that both of her parents are hypertensive, and likewise she is too. Clinical Findings The patient’s vision is 20/20 monocular and binocularly for both distance and near, with an interpupillary distance of 60/58mm and a pupil diameter of 4mm.
All the patient’s ocular adnexae are within normal limits. Static retinoscopy reveals a gross finding of +2. 50 sph for both eyes and a net finding of +0. 50 sph. The findings enable her to achieve 20/20 vision. Upon refinement during subjective refraction, her final prescription is of +0. 50 sph for the right eye and +0. 25 sph for the left eye. The patient’s near point of convergence was measured at 8/13 which is within normal limits and with push-up amplitude finding of 12 cm or 8. 33 D. Corneal reflex testing showed a reflex located slightly nasally for the left eye and centered on the right eye.
Upon further verification through alternate cover tests a slight amount of exophoria was revealed for both distance and near. Motility testing shows jerking in the patient’s smooth pursuit in all directions but smooth, accurate, full and extensive on saccades. Fundoscopic examination revealed that the internal eye for both eyes of the patient are well within normal limits and absent of any pathology. Phorometric testing reveals a habitual phoria for the patient measured at 2 xop for distance and 1 xop for near, with the same values for the induced phoria.
The amplitude of accommodation of the patient was at 7. 75D which is a determinant that the patient does not need any correction for near vision Diagnosis: The patient has Facultative Hyperopia. Discussion: Various eye care professionals, including ophthalmologists, optometrists and opticians, are involved in the treatment and management of hyperopia. At the conclusion of an eye examination, an eye doctor may provide the patient with an eyeglass prescription for corrective lenses. Minor amounts of hyperopia are sometimes left uncorrected.
However, larger amounts may be corrected with convex lenses in eyeglasses or contact lenses. Convex lenses have a positive dioptric value, which causes the light to focus closer than its normal range. Management: Full prescription should be given to the patient to aide her refractive error. References: American Optometric Association. Optometric Clinical Practice Guideline: Care of the patient with hyperopia. 1997. “Eye Health: Presbyopia and Your Eyes. ” WebMD. com. October, 2005. Accessed September 21, 2006. Chou B. Refractive Error and Presbyopia. ” Refractive Source. com Accessed September 20, 2006. American Optometric Association. Optometric Clinical Practice Guideline: Care of the patient with presbyopia. 1998. Kazuo Tsubota, Brian S. Boxer Wacher, Dimitri T. Azar, and Douglas D. Koch, editors, , Hyperopia and Presbyopia, New York: Marcel Decker, 2003 Roque, B. Refractive errors in children. November 2, 2005. “Frequently Asked Questions: How do you measure refractive errors? “. The New York Eye And Ear Infirmary. Retrieved 2006-09-13.

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